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Circle your gender: Female or Male
Circle your grade: 9th 10th 11th 12th
1. I am confident in my knowledge of how to keep myself out of an unsafe situation.
Don’t agree 1 2 3 4 5 Strongly agree
2. I believe that I have the skills to recognize an unsafe situation.
Don’t agree 1 2 3 4 5 Strongly agree
3. I believe that I have basic skills to help get myself out of an unsafe situation.
Don’t agree 1 2 3 4 5 Strongly agree
4. I feel that I am able to communicate to a date or a friend or a stranger clearly (so that they understand) my physical boundaries.
Don’t agree 1 2 3 4 5 Strongly agree
5. I believe that assault is common among teens my age.
Don’t agree 1 2 3 4 5 Strongly agree
6. I know the legal steps to take in case a friend or I have been sexually assaulted.
Don’t agree 1 2 3 4 5 Strongly agree
7. Any other comments?